Infertility Inception: Warning M 17+
I assume when most people think of infertility, they think of In-Vitro Fertilization (IVF). At least that’s what I thought of. A world filled with syringes, needles, and injections that was “hard” but magically resulted in a baby. This is far from the truth; for many, IVF is the dream within a dream within a dream. Very similar to the journey that Christopher Nolan, Leo DiCaprio, & Joseph Gordon Levitt took us on in 2010.
Inception is defined by Webster’s Dictionary as an act, instance, or process of beginning. For many battling infertility, inception is when they start trying to conceive. So many of us have the rosy outlook that we might try once, twice, or god forbid, three times, and WHAM, we’ll be pregnant. I clearly remember those days….
when a “honeymoon baby” was a realistic possibility
when I imagined if it would be better to have a summer, winter, spring, or fall baby
when having multiple children exactly three years apart seemed reasonable
all of this, a total dream.
According to the American Society for Reproductive Medicine, it is recommended that if couples don’t achieve pregnancy after one year of trying, that they seek medical support. If a woman is over the age of 35, then the recommendation is to seek help after 6 months. As you can imagine, after 6 or 12 months of trying, the reality of a one-and-done pregnancy has not only gone out the window, it’s halfway to the other side of the world. Saul and I were lucky, in that my Polycystic Ovarian Syndrome (PCOS) warranted earlier intervention (see “The Talk” : Life Lessons Years Later for a quick introduction to this syndrome). We tried to get pregnant naturally for a few months, but shortly after, started having conversations with my OBGYN that other couples without a known condition, would wait 6 months — 1 year to have.
Due to my PCOS, I have many more immature follicles/eggs in my ovaries at the beginning of a menstrual cycle than a woman without PCOS. Therefore, my body expends energy growing the numerous follicles/eggs in my body, but due to the sheer volume of them, none of them make it to a mature size. With this knowledge, it was prescribed that Saul and I start with medicated cycles. This entailed a call to my OBGYN office on Day # 1 of my cycle. They would then send a prescription to my pharmacy — for me, this was Letrozole, for others it is Clomid. I would orally take Letrozole from Day #3 — #12 of my cycle with the sole purpose being to grow one or more follicles to maturity. During this time, I typically visited my OBGYN office two to three times for vaginal ultrasounds, allowing the sonographer to see how my follicles were growing and measure how many were reaching the ideal size. Typically, they were looking for at least one follicle to reach anywhere between 16mm — 20mm in size; this was indicative of a mature egg inside the follicle. Once the ultrasounds showed one or more follicles (yes, a possibility of twins or triplets) at the ideal size, I was then given an Ovidrel injection, which induced ovulation. Ovulation is when a mature egg is released from the ovary and pushed down the fallopian tube, making it available to be fertilized by sperm.
For the first few months of this process, Saul and I were “prescribed” to have timed intercourse. This was not the romantic experience that you are picturing. Instead, it sometimes felt like a precise and clinical procedure. During the average woman’s cycle, there is a window of about 6 days when intercourse can result in pregnancy. Five days before ovulation and the day of ovulation itself. Based on when I was given the Ovidrel injection to induce ovulation, we had to time out exactly when to have intercourse. Note that higher rates of conception occur when couples have intercourse every-other-day. It was like we were back in elementary school using our abacus and analog clock to work backwards in 24 hour increments to determine the best plan of action. I clearly remember those days…..
when our “plan of action” was so precise that it couldn’t fail
when watching my follicles grow was exciting
when I imagined what it would be like to not only have one baby, but twins
all of this, a total dream. A dream within a dream.
After a few months of failed attempts at these medicated cycles, my provider suggested Saul get fertility testing, which resulted in results indicating low sperm count (see “The Talk” : Life Lessons Years Later for more information on this). We immediately changed our plan of action to include medicated cycles with the inclusion of Intrauterine Insemination (IUI). I still took Letrozole Day #3–12, visited the OBGYN for ultrasounds, and gave myself the Ovidrel injection when my follicles were the ideal size. However, along with timed intercourse, we also included IUI.
IUI is a fertility treatment where sperm is deposited directly into the woman’s uterus. The sperm still needs to swim from the uterus to the fallopian tubes to reach and fertilize an egg, but this process eliminates the long swim from the vaginal canal through the cervix and into the uterus. Additionally, prior to the insemination, the sperm are washed, meaning the sperm cells are separated from the semen, helping to get rid of chemicals and slow moving or dead sperm. Basically, it’s fertility's version of Olympic qualifiers.
Just like everything else in the fertility world, an IUI had to be precisely timed. The IUI procedure had to occur exactly 36 hours after I injected myself with Ovidrel. Therefore, once my provider deemed my follicles ideal in size, we would schedule the IUI procedure to occur in the next 1.5 days, and work backwards to calculate when I would need to give myself the Ovidrel shot. Only once did I get lucky, where the clinic team was able to give me the shot at my appointment. Most of the time, I was waking up in the middle of the night at 12am or 3am to give myself the injection.
On the day of the IUI, Saul would give his sample in a container at home 30 minutes before my appointment. I was instructed to keep it warm by stuffing it down my shirt. No, I am not kidding.
I would show up at my provider’s office, and sheepishly bring the sample directly to the lab. They would take 30 minutes to wash the sperm and get it injected into a catheter. I would then have the fun job of getting up onto the table and into the stirrups, to complete the IUI. The provider would clamp my cervix open (ouch), wash it with some solution (double ouch), and feed the extremely small catheter through my cervix and up into my uterus (triple ouch). Once they got to the right spot, they would inject me with the washed sperm.
Across all patient types, IUI has a success rate between 5–15%. Repetition can be a factor to increase success rates. However, research shows that the majority of successful IUIs resulting in a full-term pregnancy will occur within 3–4 attempts.
Saul and I attempted 4 IUIs — March 2021, May 2021, June 2021, & July 2021.
After our 2nd IUI in May 2021, Saul and I decided to take a much needed long-weekend in North Carolina. It just so happened that the end of the “two week wait” — or the two weeks between an IUI procedure and ability to get an accurate reading on a pregnancy test — fell during our vacation. I was constantly symptom checking. Did I feel slightly nauseous today? Was that twinge I felt in my stomach implantation cramping? Was I using the bathroom more frequently than usual? I thought I felt different and I was convinced this would finally be the month to celebrate. I packed pregnancy tests and even bought Saul a shirt that said “Daddy Shark” to give him if we had a positive test. On one of our last mornings, I did the deed, peed on a stick, and waited the allotted 5 minutes before checking.
It couldn’t be true. I did feel nauseous! I did have twinges in my stomach! I was peeing more than usual! This couldn’t be right. Maybe I had tested too early and the hCG (the hormone that pregnancy tests detect) was not high enough to show up on the test.
I brought the test out to the kitchen table at our AirBnB and sat it in the light. With better lighting I’d be able to see the second pink line.
I set my wedding ring on top of the test, as I had read in trying-to- conceive blogs that this helped the camera focus on the lines and detect a second line, even if faint.
I took a picture of the test and inverted it, as the second line, even if faint, would be visible with this feature. I clearly remember those days….
when I would plan ways to tell Saul we were pregnant and imagine the pure joy in his reaction
when I thought I’d be able to give my mother and mother-in-law the best Mother’s Day gift
when luck, and not probability or statistics had to be on our side
all of this, a total dream. A dream within a dream within a dream.
The process became second nature — track my cycle, call the OBGYN office on cycle day #1, pick up my prescription at Walgreens, take Letrozole cycle days #3–12, have ultrasounds completed, give myself an injection, have timed intercourse, complete the IUI procedure. Wait two weeks to take a pregnancy test. Repeat. Repeat. Repeat. The whole thing started to feel robotic. And perhaps that was a blessing at the time. The step-by-step approach to IUI allowed me to focus on the next step ahead of us — a defense mechanism of sorts in not having to constantly emotionally process everything we were going through.
Infertility is frustrating, isolating, discouraging, angering, and unfair. Every time a cycle fails, it’s hard not to look back and feel sorry for yourself and the time, money (at this point, we were $5K out-of-pocket), and emotional energy you put into something that simply put: failed. It’s the complete definition of “crash” — to move or cause to move with force and speed. One minute, you are filled with hope, the next you are absolutely devastated. And oftentimes, there isn’t a clear solution. The solution is to get up off the floor, brush yourself off, and do it again.
As challenging as this period was, Saul and I often talk about how medicated cycles and IUIs prepared us for the second half of our fertility journey. Little did we know, we were only getting started. Although a dream within a dream within a dream, I clearly remember those days…..
when I was reminded that life isn’t fair
when I learned that a prescribed solution doesn’t always ensure a desired outcome
when I learned how much I value my relationship
when I realized how badly we wanted this dream to be true
To learn more about our journey, please visit our GoFundMe page.